GPs agree new contract

Under the plans, GPs will also take on more responsibility for out-of-hours care

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The Government and GPs have agreed a new contract which will focus on keeping more patients out of hospital.

The changes will mean every person aged 75 and over will be assigned a named, accountable GP to ensure patients receive co-ordinated care.

GPs will also take on more responsibility for out-of-hours care, with a commitment to monitor the quality of out-of-hours services used by their patients.

Concerns have been raised over the quality of out-of-hours care since a 2004 GP contract enabled family doctors to opt out of night and weekend care by sacrificing £6,000 a year in salary.

Under the new agreement, there will be an "enhanced service" for patients with complex health needs to avoid them being unnecessarily admitted to hospital or A&E.

Emergency care departments will have easier telephone access to GPs to decide whether or not a patient needs to be admitted.

And new IT systems will improve the ability of patients to book appointments online and to access their summary medical record.

The quality and outcomes framework (QOF) - which financially rewards GPs for hitting targets in areas such as diabetes care - will also be cut.

Some 238 QOF points (worth around £290 million) will be made part of the core GP funding, and a further 100 points will fund part of the enhanced service to prevent patients being inappropriately admitted to hospital.

A test will also be introduced from next December as part of the NHS Friends and Family scheme asking patients how likely they are to recommend a GP practice.

The British Medical Association (BMA), which negotiated for doctors, said the changes would cut unnecessary targets, reduce bureaucratic box-ticking and give doctors more time to focus on the needs of their patients.

"From the outset of this year's contract talks, the BMA has sought to positively engage with the Government to address the difficult financial and workload pressures facing general practice, in order to find new ways of improving patient care, while at the same time freeing up GPs and practice nurses from pointless bureaucracy.

"Our agreement will deliver real benefit to patients and build on the work already carried out by GPs.

"Most importantly, the Government has listened to the concerns of the BMA and reversed the adverse impact of last year's contract changes, which resulted in the introduction of unnecessary targets and excessive paperwork, freeing up resources for GPs to use their clinical judgment, not a checklist, when treating their patients.

"This will not only free up GPs to spend more time focusing on treating patients, but will also mean that valuable resources will be reinvested in general practice to improve frontline care.

"We have also negotiated changes that will encourage GPs to provide more personalised care for vulnerable patients at risk of hospital admission, with improved access and other measures to better co-ordinate their care."

Dr Nagpaul said the BMA had also managed to keep age-related pay progression for the next six years for doctors already receiving it.

Dr Clare Gerada, chair of the Royal College of GPs, said: "This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.

"The quality and outcomes framework has been a successful system for improving patient outcomes in general practice but red tape and misdirected financial incentives are increasingly taking priority over patients' needs.

"GPs need to have the time to listen to their patients, discuss the issues that are important to them, and be free to use professional judgment and medical evidence to provide the best personalised care possible according to the patient's individual needs.

"Preventing disease is a very important part of a GP's role.

"But expecting hard pressed GPs - who are already struggling to cope with spiralling workloads but ever decreasing resources - to fill in questionnaires and randomly screen the wider population for very specific diseases is not an effective way of caring for patients or a cost-effective use of NHS money that could be better used elsewhere."

"It piled target after target on doctors, took away their responsibility for out-of-hours care and put huge pressure on our A&E departments.

"This Government has a plan to sort this out and today's announcement of a new GP contract is a vital step.

"We are bringing back named GPs for the vulnerable elderly. This means proper family doctors, able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital.

"Rigorous new inspections of GP surgeries will mean every local person will know whether they are getting the care they deserve.

"This is about fixing the long-term pressures on our A&E services, empowering hard-working doctors and improving care for those with the greatest need."

Shadow health secretary, Andy Burnham, said: "No amount of spin can hide the fact that David Cameron has made it harder to get a GP appointment. "There is nothing in this new contract to correct that.

"David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours. This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment - many of whom, not happy with a phone consultation, will still turn to A&E.

"People will fail to see how this package delivers the public commitment David Cameron gave last month to keep GP surgeries open from 8am to 8pm.

"It was another promise that he's got no intention of keeping and shows why he's not trusted on the NHS."

Dame Barbara Hakin, chief operating officer and deputy chief executive at NHS England, said: "As a GP myself for many years, I know the importance of being able to do what we have been trained for - to use our professional clinical judgment to provide care and treatment that meets all aspects of a patient's needs.

"We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital - in fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference."

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